The evaluation of the efficacy of steroid iontophoresis in patients with rheumatoid arthritis

Aim: Comparative evaluation of direct current and steroid iontophoresis treatments in patients with active wrist synovitis with rheumatoid arthritis.Material and Methods: Rheumatoid arthritis (RA) is a chronic, inflammatory disease that causes pain, swelling and limitation of motion, keeping wrist and hand joints symmetrical. In this study, we examined the efficacy of steroid iontophoresis with direct current to the wrists of active RA patients. 20 active patients with RA and wrist synovitis were included in the study. Steroid iontophoresis applied in one wrist of these patients, direct current to the other wrist (control). Patients’ number of painful joints (NPJ), number of swollen joints (SJN), hand grip strength (HG), lateral grip strength (LG), Hand Functional Evaluation (HFE), Health Assessment Questionnaire (HAQ), Disease Activity Score-28 (DAS-28) and power Doppler ultrasonography (PDUS) were compared.Results: Clinical and laboratory parameters were significantly improved according to pre-treatment (Pr-T) and post-treatment (Pst-T). We found significant improvement in Pr-T and Pst-T in the cases of HG, LG, HFE, SJN and NPJ in the wrist in treatment and control, but there was no significant difference between the control wrist and the treated wrist. There were no changes in Pr-T and Pst-T in grades, if any, resistive index (RI) and pulsatility index (PI) values of PDUS with pannus and current in hand wrist.Conclusions: Our results showed no difference between the steroid iontophoresis and direct current therapy in patients with RA who were active and have wrist synovitis in Pr-T and Pst-T.

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Wollheim FA. Rheumatoid arthritis the clinical picture. In: Maddison PJ, Isenberg DA, Woo P, Glass DN, eds. Oxford Textbook of Rheumatology Atlanta: Oxford Press; 1998:1004–30.
Ergin S. Romatoid artrit ve Sjögren sendromu. Beyazova M, Gökçe-Kutsal Y eds. Fiziksel Tıp ve Rehabilitasyon. Ankara: Öncü Basımevi, 2000;1549-76.
Gümüşdiş G. Romatoid artrit. In: Gümüşdiş G, Doğanavşargil E, eds. Klinik Romatoloji. İstanbul: Deniz Matbaası, 1999:269-78.
Felson D. Epidemiology of the rheumatic diseases. In: Koopman WJ, ed. Arthritis and Allied Conditions. Philadelphia: Lippincott Williams and Wilkins, 2001;1:3–38.
Theodorou DJ, Theodorou SJ, Resnick D. Imaging of rheumatoid arthritis. In: Hochberg MC, Silman AJ, Smolen JS, Weinblatt ME, Weisman MH, eds. Rheumatology. 3rd ed, Mosby, 2003:801-10.
Taouli B, Guermazi A, Genant HK. Imaging of the hand and wrist in RA. Ann Rheum Dis 2002;61:867-9.
Szkudlarek M, Court-Payen M, Strandberg C, et al. Power Doppler ultrasonography for assessment of synovitis in the metacarpophalangeal joints of patients with rheumatoid arthritis. A comparison with dynamic magnetic resonance imaging. Arthritis Rheum 2001;40:2018–23.
Levent Ö, Ataman Ş. Romotoid artrit tedavisinde yeni yaklaşımlar. T Klin. FTR 2002;2:124-42.
Basford JR. Physical Agents. In: De Lisa J.A, Gans B.M, eds. Rehabilitation Medicine Principles Pratice, 3rd editon, Philadelphia, lippincott Raven 1998;483-503.
Kayhan Ö. Electroteherapy, Kayhan Ö. Ed. physical medıcıne and rehabilitation, İstanbul, 1995;109-55.
Arnet FC, Edworthy SM, Bloch DA, et al.The American Rheumatism Association 1987 revised criteria for the classification of rheumatoid arthritis. Arthritis Rheum 1988;31:315–24.
Fransen J, Stucki G, Van Riel LCM. Rheumatoid Artritis Measures. Arthritis Rheum 2003;49:214–24.
Klauser A, Frauscher F, Schirmer M. Comment Letter. Eur Radiol 2004;14:545-46.
Weber DC. Brown AW. Physical agent modalities. In: Braddom RL, ed. Physical Medicine & Rehabilitation. Philadelphia: WB Saunders Company 1996;449-63.
Chantraine A, Ludy JP, Berger D. Is Cortisone Iontoporesis Possible? Arch Phys Med Rehabil. 1986;67:38–40.
Neeter C, Thomee R, Silbernager KG, et al. Iontophoresis with or without dexamethazone in the treatment of acut achilles tendon pain. Scand J Med Sci Sports 2003;3:376–2.
Ozgocmen S, Kiris A, Ardicoglu O, et al. Glucocorticoid iontophoresis for Achilles tendon enthesitis in ankylosing spondylitis: significant response documented by power Doppler ultrasound. Rheumatol Int. 2004;
Grassi W, Filippucci E. Is power doppler sonography the new frontier in therapy monitoring? Clin Exp Rheumatol 2003;21:424–8.
Stone M, Bergin D, Whelan B, et al. Power Doppler ultrasound assessment of rheumatoid hand synovitis. J Rheumatol 2001;28:1979–82.
Teh J, Stevens K, Williamson L, et al. Power Doppler ultrasound of rheumatoid synovitis: quantification of therapeutic response. Br J Radiol 2003;76:8759.
Kalia Y N, Naik A, Garrison J, Guy R H. Iontophoretic drug delivery. Adv Drug Deliv Rev 2004;56:619-58.
Anderson CR, Morris RL, Boeh SD. Effects of Iontophoresis Current Magnitude and Duration on Dexamethasone Deposition and Localized Drug Retention. Phys Ther 2003;83:161-70.
Nirschl RP, Rodin DM, MD, et al. Iontophoretic administration of dexamethasone sodium phosphate for acute apicondylitis. Am J Sports Med 2003;31:189-95
Tuna N. Doğru akım. Elektroterap. In: Tuna N, ed. İstanbul Nobel Tıp Kitapevleri, 2001;51-62.